Jordan Louis Fuller, PT, DPT, LAT, ATC

NPI #1992214803 in Waltham, Massachusetts

Provider Information

NPI Number: 1992214803
Entity Type: Individual
Name: Jordan Louis Fuller, PT, DPT, LAT, ATC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: PT, DPT, LAT, ATC
Enumeration Date: Sep 22, 2017
Last Updated: Nov 10, 2022

Practice Location

Address: 840 WINTER ST
City: Waltham
State: Massachusetts
ZIP Code: 02451-1433
Phone: (781) 487-9944

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Medicine & Rehabilitation - Sports Medicine — Sports Medicine	2081S0010X
Physical Therapist	225100000X	Primary

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